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Meta-Analysis
. 2016 Feb 17;11(2):e0148756.
doi: 10.1371/journal.pone.0148756. eCollection 2016.

Multivessel versus Single Vessel Angioplasty in Non-ST Elevation Acute Coronary Syndromes: A Systematic Review and Metaanalysis

Javier Mariani  1   2 , Alejandro Macchia  2 , Maximiliano De Abreu  1 , Gabriel Gonzalez Villa Monte  1 , Carlos Tajer  1
Affiliations
Meta-Analysis

Multivessel versus Single Vessel Angioplasty in Non-ST Elevation Acute Coronary Syndromes: A Systematic Review and Metaanalysis

Javier Mariani et al. PLoS One. .

Abstract

Background: Multivessel disease is common in acute coronary syndrome patients. However, if multivessel percutaneous coronary intervention is superior to culprit-vessel angioplasty has not been systematically addressed.

Methods: A metaanalysis was conducted including studies that compared multivessel angioplasty with culprit-vessel angioplasty among non-ST elevation ACS patients. Since all studies were observational adjusted estimates of effects were used. Pooled estimates of effects were computed using the generic inverse of variance with a random effects model.

Results: Twelve studies were included (n = 117,685). Median age was 64.1 years, most patients were male, 29.3% were diabetic and 36,9% had previous myocardial infarction. Median follow-up was 12 months. There were no significant differences in mortality risk (HR 0.79; 95% CI 0.58 to 1.09; I2 67.9%), with moderate inconsistency. Also, there were no significant differences in the risk of death or MI (HR 0.90; 95% CI 0.69 to 1.17; I2 62.3%), revascularization (HR 0.76; 95% CI 0.55 to 1.05; I2 49.9%) or in the combined incidence of death, myocardial infarction or revascularization (HR 0.83; 95% CI 0.66 to 1.03; I2 70.8%). All analyses exhibited a moderate degree of inconsistency. Subgroup analyses by design reduced the inconsistency of the analyses on death or myocardial infarction, revascularization and death, myocardial infarction or revascularization. There was evidence of publication bias (Egger's test p = 0.097).

Conclusion: Routine multivessel angioplasty in non-ST elevation acute coronary syndrome patients with multivessel disease was not superior to culprit-vessel angioplasty. Randomized controlled trials comparing safety and effectiveness of both strategies in this setting are needed.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chat of studies.
Fig 2
Fig 2. Effects of MV PCI versus CV PCI on mortality.
Fig 3
Fig 3. Effects of MV PCI versus CV PCI on secondary outcomes.
Fig 4
Fig 4. Unadjusted analyses of MV PCI versus CV PCI.
Fig 5
Fig 5. Subgroup analyses by quality of study report assessed by Newcastle-Ottawa Scale.
Fig 6
Fig 6. Subgroup analyses by follow-up.
Fig 7
Fig 7. Subgroup analyses by DES use.
Fig 8
Fig 8. Subgroup analyses by diabetes prevalence.
Fig 9
Fig 9. Subgroup analyses by chronic occlusions prevalence.
Fig 10
Fig 10. Subgroup analyses by studies design.
Fig 11
Fig 11. Sensitivity analyses with odds ratios transformation to risk ratios.
Fig 12
Fig 12. Sensitivity analyses excluding studies with follow-up limited to initial hospitalization.
Fig 13
Fig 13. Funnel plots of adjusted (13A) and unadjusted (13B) estimates.
See this image and copyright information in PMC

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